. TGF␤ signaling in lung epithelium regulates bleomycin-induced alveolar injury and fibroblast recruitment. Am J Physiol Lung Cell Mol Physiol 300: L887-L897, 2011. First published March 25, 2011; doi:10.1152/ajplung.00397.2010The response of alveolar epithelial cells (AECs) to lung injury plays a central role in the pathogenesis of pulmonary fibrosis, but the mechanisms by which AECs regulate fibrotic processes are not well defined. We aimed to elucidate how transforming growth factor-␤ (TGF␤) signaling in lung epithelium impacts lung fibrosis in the intratracheal bleomycin model. Mice with selective deficiency of TGF␤ receptor 2 (TGF␤R2) in lung epithelium were generated and crossed to cell fate reporter mice that express ␤-galactosidase (␤-gal) in cells of lung epithelial lineage. Mice were given intratracheal bleomycin (0.08 U), and the following parameters were assessed: AEC death by terminal deoxynucleotidyl transferase dUTP-mediated nick-end labeling assay, inflammation by total and differential cell counts from bronchoalveolar lavage, fibrosis by scoring of trichromestained lung sections, and total lung collagen content. Mice with lung epithelial deficiency of TGF␤R2 had improved AEC survival, despite greater lung inflammation, after bleomycin administration. At 3 wk after bleomycin administration, mice with epithelial TGF␤R2 deficiency showed a significantly attenuated fibrotic response in the lungs, as determined by semiquantitatve scoring and total collagen content. The reduction in lung fibrosis in these mice was associated with a marked decrease in the lung fibroblast population, both total lung fibroblasts and epithelial-to-mesenchymal transition-derived (S100A4 ϩ

Background: This study aimed to assess the measurement properties (reliability, factor structure, and criterion validity) of the Patient Health Questionnaire (PHQ-9) as an instrument for screening major depressive disorder (MDD) in elderly primary care users in Chile. Method: About 582 participants aged between 65 and 80 years were enrolled from primary care centers. They completed the Composite International Diagnostic Interview (CIDI), a survey with sociodemographic characteristics and the PHQ-9. Results: The PHQ-9 revealed an acceptable internal consistency (ω = 0.79 [95% CI: 0.75–0.80] and α = 0.78 [95% CI: 0.75–0.81]); confirmatory factor analysis demonstrated a good fit for both 1- and 2-factor solutions. The chi-square difference test (χ 2 = 0.61, gl = 1, p = 0.43) and correlation between the somatic and the cognitive-effective latent factors were very high ( r = 0.97, p < 0.001), indicating that the 1 factor model was more parsimonious. Utilizing the CIDI as the gold standard, the area under the curve (AUC) was 0.88 (SE = 0.04, 95% CI: 0.84–0.90). The optimal cut-off score of ≥ 6 yielded good sensitivity and specificity for detecting MDD (0.95 and 0.76, respectively). However, considering the clinical utility index, the cut-off score of ≥9 proved to be a more effective marker for discarding cases of MDD. Conclusion: The PHQ-9 has adequate psychometric properties for elderly primary care users. In clinical settings, it showed its greatest utility in ruling out the presence of an MDD, however, its clinical value for identifying possible cases of MDD is limited. In cases above the cut-off point, it is recommended to perform a more thorough evaluation.

Patients with metabolic syndrome improved after gastric bypass, with results lasting after 2 years; other metabolic parameters important for cardiovascular risk were also positively affected. There was a relationship between the amount of weight loss and improvement of metabolic syndrome.

Background: People with severe mental disorders (SMDs) have higher disease and death rates than the general population. Stigma (negative attitudes and perceptions) contributes to limited access to health services and a lower quality of medical assistance in this population, and it is manifested as negative attitudes, social distance, and discrimination toward this social group. For these reasons, healthcare workers are a priority group for anti-stigma interventions. This study aims to assess the effectiveness of a program specifically designed to decrease negative attitudes and social distance and increase inclusive behaviors in healthcare workers toward people with SMD.Methods: The study will be a randomized clinical trial. A minimum of 210 healthcare workers from 11 primary care centers in the province of Concepción, Chile, will be randomly chosen to receive the program or be part of the control group. There will be a pre-, post-, and 4-months evaluation of social distance, attitudes, and behaviors of participants toward people with SMD using standardized scales such as the social distance scale, which is a scale of clinician attitude toward mental illness adapted from attitudes of clinicians toward mental illness, and self-reports. The intervention program will consist of education strategies, direct, and indirect contact with people diagnosed with SMD, and skill development. There will be six face-to-face sessions directly with the participants and two additional sessions with the directors of each healthcare center. The program will involve a facilitator who will be a healthcare professional and a co-facilitator who will be a person diagnosed with SMD.Discussion: This study will evaluate an intervention program especially designed to reduce stigma in healthcare workers toward people with SMD, a topic on which there is little background information, particularly in low- and middle-income countries. It is important to have interventions with proven effectiveness for this purpose to ensure equity in healthcare services.Trial Registration: This study was registered under ISRCTN.com (ISRCTN46464036).

BCC, Basal cell carcinoma; BSC, basosquamous cell carcinoma; DFSP, dermatofibrosarcoma protuberans; DVT, deep vein thrombosis; EMPD, extramammary Paget disease; Gyn, gynecology; Gyn onc, gynecology oncology; n/a, not applicable; OBGYN, obstetrics and gynecology; Postop, postoperative; SCC, squamous cell carcinoma; VC, verrucous carcinoma. *Defect size was only reported in 2 cases. y In 3 of 107 cases, recurrence was not reported, and these were not included in the calculation of recurrence rate.